An emergency stroke treatment pioneered by a world-renowned team of specialists in Edinburgh has been commended by a national watchdog as a model the rest of the UK should follow. 

Experts at the Western General Hospital have found that if some stroke victims are treated with clot-busting drugs within three hours, their chances of recovering are radically improved. 

The treatment, together with initiatives to administer it quickly, have now been highlighted by the National Audit Office (NAO) as a shining example to the NHS in Britain. 

NHS Lothian now plans to use computer technology to provide round-the-clock care by linking consultants to hospitals so they can examine a patient's brain scan and determine if the treatment is safe. 

From the new year, stroke patients at the Western General, Edinburgh Royal Infirmary and St John's Hospital in Livingston will benefit from the new "telemedicine" link. 

A stroke is a type of brain injury which often effects the elderly and is often due to blockage of an artery in the brain by a blood clot. 

Time is of the essence when treating stroke victims as medics battle to prevent permanent damage by preventing brain cells from dying. 

The experts at the Western General have discovered that some patients can benefit from emergency treatment with thrombolytic, or clot-busting, drugs which can restore blood flow before major brain damage has occurred. 

Professor Martin Dennis, who leads the Lothian stroke team - the first of its kind in the world - warned that the drugs could also be fatal in some patients. 
To ensure patients were suitable, stroke unit staff had been trained to give brain scans so patients could be evaluated promptly. 

"It really is a race against time," he said. 

"Clot-busting drugs have been used to treat heart attacks in the last ten to 15 years and we now have very good evidence to suggest it is effective in treating acute ischaemic stroke. 

"But 15 per cent of patients are left with bleeding in the brain and it would be very dangerous to give them clot-busting drugs." The experts are also now looking at how clot-busting drugs could be used to benefit patients who had suffered a stroke six hours before receiving treatment. 

As 5000 patients will be needed for the trial, the team hope to get hospitals from across the world on board to speed up the time it takes to reach conclusions. 

Dr Alison Bramley of the Lothian Stroke Managed Clinical Network said that huge investment had been made in rehabilitation services. 

As well as providing a greater number of beds in specialist stroke units, NHS Lothian has also appointed its first consultant physiotherapist to specialise in helping victims recover. 

Dr Bramley added: "We need to make sure the real expertise reaches the right people as quickly as possible." 

Commenting about the NAO report, Edward Leigh, chairman of the House of Commons Public Accounts Committee, said: "It [stroke] devastates families, leaves survivors with serious disabilities, uses a significant proportion of in-patient beds and nursing home places, and ultimately costs us around £7 billion a year."

THE FACTS

Every year, 100,000 people in the UK suffer strokes for the first time. About ten per cent of them are under retirement age, with around one per cent aged under 30. 

A stroke occurs when part of the brain is suddenly severely damaged or destroyed. It takes place either when a blood clot forms in a damaged vessel and blocks the flow of blood to part of the brain or when a damaged vessel in the brain bursts. 

Without oxygen and nutrients, nerve cells in the brain die within minutes. When this happens, the part of the body controlled by these cells will fail to function properly as well. The effects are often permanent. 

Symptoms of minor episodes include temporary weakness or numbness in an arm or leg, and may precede a major stroke. More serious strokes often see the victim suffer slurring or loss of speech, difficulty swallowing, the mouth may droop, and there may be dribbling, headache, dizziness and confusion. 

The single most important risk factor is high blood pressure (hypertension) which probably accounts for around 70 per cent of all strokes.
Treatment in Lothians that suffers by comparison.

Despite the pioneering work at the Western General, other hospitals in the Lothians are failing to meet tough standards which demand that all stroke patients in Scotland are treated as an emergency. 

NHS inspectors today reported that treatment with aspirin was also being delayed because consultants did not have access to brain scan results. 
Standards set by NHS Quality Improvement Scotland demand that aspirin treatment is initiated within 48 hours of admission. 

QIS demands that 80 per cent of patients are given a brain scan within 48 hours of admission so the appropriate treatment can be administered quickly. 
NHS Lothian says this has now been addressed by staff training and new computer systems. The health authority did meet standards for the education and training of stroke unit staff and for assessing a patient's rehabilitation needs.